Narrator: Imagine performing a routine, life-saving surgery, only to be served with a lawsuit two years later. The procedure had a known, unavoidable risk, which you explained to the patient. The complication occurred, you fixed it immediately, and the patient recovered. Yet, you are now accused of negligence by lawyers described as "Messrs Cunt, Cuntsome and Cuntiest." You spend months buried in paperwork, attending meetings, and reliving every second of the operation, your confidence shattered. The hospital eventually settles, but the damage is done. You are left questioning your competence, your career, and your sanity. This isn't a hypothetical scenario; it's a glimpse into the world that broke Adam Kay, a junior doctor in the UK's National Health Service. In his unflinching and darkly hilarious memoir, This is Going to Hurt, Kay opens his secret diaries to reveal the brutal reality of life on the front lines of medicine.

Narrator: The journey to becoming a doctor often begins with a decision made with startling immaturity. As Adam Kay points out, "Every doctor makes their career choice aged sixteen, two years before they’re legally allowed to text a photo of their own genitals." This choice, based more on academic aptitude and parental expectation than a true understanding of the profession, sets a person on a long and unforgiving path.

The selection process itself is deeply flawed. Kay critiques medical schools for prioritizing extracurricular achievements over the qualities that actually make a good doctor: compassion, empathy, and psychological resilience. He notes, "Medical schools don’t give the shiniest shit about any of that... Instead, they fixate on extracurricular activities." This focus on piano grades and sports trophies over an applicant's ability to handle blood, death, and immense pressure creates a system that may select for high achievers, but not necessarily for caring and stable physicians. The case of Harold Shipman, a respected doctor who was also a prolific serial killer, serves as a chilling reminder that academic success is no guarantee of ethical character. The result is a generation of doctors who are academically brilliant but often woefully unprepared for the emotional and psychological onslaught that awaits them.

Narrator: The transition from medical school to the hospital ward is a shock to the system. The first year as a House Officer is a trial by fire, a period defined by overwhelming responsibility and a near-vertical learning curve. The chaos peaks on "Black Wednesday," the first Wednesday of August when all junior doctors in the UK change hospitals simultaneously. Kay notes with grim humor that death rates are known to spike on this day, a fact that "really takes the pressure off."

The daytime shifts are manageable, but the night shifts are a descent into a special kind of hell. A single, newly qualified doctor is often left in charge of hundreds of patients across multiple wards. They are bombarded with bleeps, each one signaling a potential crisis, from a patient vomiting blood to another in cardiac arrest. Kay describes working a staggering 97 hours in one week, a clear violation of the European Working Time Directive that hospitals pressured doctors to opt out of. It is a relentless, high-stakes environment where, as Kay puts it, "It’s sink or swim, and you have to learn how to swim because otherwise a ton of patients sink with you."

Narrator: The life of a junior doctor oscillates wildly between the profoundly tragic and the utterly absurd. Kay's diaries are a testament to this emotional whiplash. One day, he might be treating a man who, in a drunken stupor, has "degloved" his own penis by sliding down a lamppost. The next, he could be helping a woman propose to her boyfriend by extracting an engagement ring hidden inside a Kinder Surprise egg from a place it was never meant to be.

This dark humor is a necessary coping mechanism in a job filled with trauma. Kay recounts the horror of his first patient death, a man who bled out from oesophageal varices, covering the room in what looked like an "avant-garde changing room." He describes the gut-wrenching experience of diagnosing a stillbirth in a couple who are both doctors themselves, and the inadequacy he feels in the face of their grief. He writes, "You shouldn’t have to bury your child," a simple, devastating truth that medical school cannot prepare you for. The job’s psychological toll is immense, leading Kay to realize, after reflexively jumping to his feet at the sound of a pizza pager, that "Work has pretty much given me PTSD."

Narrator: The NHS, while a cherished institution, runs on the goodwill and personal sacrifices of its staff. Junior doctors are treated as interchangeable cogs in a machine, rotated to new hospitals every six to twelve months. This nomadic existence makes it nearly impossible to build a stable personal life. Kay describes his partner, H, as a "medical widow, post-shift counsellor and now nomad," highlighting the strain the job places on relationships. He is forced to miss his best friend's stag do because of a last-minute shift change, a common occurrence in a system with no slack.

This lack of support is systemic. When Kay gets food poisoning from a patient's family's moussaka and calls in sick, his registrar is unsympathetic, telling him to find his own cover. The pay is shockingly low for the level of responsibility, and the only "bonus" available is a morbid £40 payment for signing a form to confirm a deceased patient doesn't have an explosive pacemaker before cremation. The unwritten rule is that doctors must choose between their own well-being and their patients' safety. As Kay states, "The former is annoying, the latter means that people die – so it’s not really a choice at all."

Narrator: For Adam Kay, the end came after a catastrophic delivery. A mother was permanently harmed and her baby suffered severe complications. Though an inquiry cleared him of any negligence, the "might have" haunted him. He felt that if he had been a slightly better doctor, the outcome might have been different. This single event broke him, transforming him into an over-cautious, fearful physician who could no longer bear the weight of the responsibility.

This experience is a personal illustration of a wider crisis. A senior consultant once grimly told her trainees that by the time they retired, there would be a "bus full of dead kids and kids with cerebral palsy, and that bus is going to have their name on the side." It is a brutal acknowledgment of the inevitability of tragedy in medicine. Faced with this emotional burden, coupled with political attacks and deteriorating conditions, many doctors are choosing to leave. Kay's decision to hang up his scrubs was not an isolated incident but a symptom of a system pushing its most vital resource to the breaking point.

Narrator: The single most important takeaway from This is Going to Hurt is that the National Health Service is a fragile ecosystem, sustained not by government funding or efficient management, but by the relentless, underpaid, and emotionally draining labor of its junior doctors. The book is a raw, hilarious, and heartbreaking cry for help, exposing a system that takes the brightest and most dedicated individuals and grinds them down until they are broken or forced to flee.

Adam Kay’s final challenge is not to his readers, but to the UK's Secretary of State for Health. He urges them to put down the spreadsheets, leave the press conferences, and work a real shift on the ward. He dares them to deliver a stillborn baby, to comfort a dying patient, to witness a traumatic amputation, and then "question a single doctor’s motivation." It is a powerful final thought, leaving us with the unsettling question: What happens when the people we depend on to save our lives can no longer save themselves?